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As Aristotle said, a swallow does not make a summer. Similarly, the GOP defeat on Tuesday night does not ineluctably make the 2012 elections wintry for Republicans. Yet at the same time, Republicans should regard this loss as an obvious warning sign that their House majority is endangered - attention must be paid.

The American people like Medicare. Polls have always shown that they would rather see taxes raised (at least on the rich) than see Medicare cut. Medicare, like Social Security, is one of those programs that American will fight to protect, because it appeals to their sense of reciprocal solidarity: everyone puts in, everyone takes out. Parties ignore that reality at their peril. Over the last three decades, Republicans, for example, have attempted to cut entitlement spending in 1981, 1986, 1995, and 2005 - each time with results ranging from disappointment to disaster. And so last night’s GOP defeat merely further proved the rule.

At the same time, everyone understands, however vaguely, that future fiscal trends will make us Greece. Yet even so, we can’t cut our way out of this Medicare crisis, nor can we tax-increase our way out. Thus the challenge: Identify Medicare reforms that the American people will accept.

There’s only one viable answer: scientific transformation leading to lower costs, as we have seen in so many other societal sectors - indeed, it’s the story of the industrial revolution itself. And so we need to re-envision health care as a medical-scientific quest. As we all know from our own encounters with doctors and hospitals, the essential medical experience is not fiscal, it’s physical. Are we healthy, or not? Both parties have misapprehended this point, leading them to prescribe fiscal medicine, when it’s real medicine that’s wanted.

We need medical advances that make aging less expensive - most obviously, progress on Alzheimer’s, leading to a cure. That would save trillions over coming decades. In addition, progress on Alzheimer’s could be linked to a raising of the retirement age, whereupon the entitlement crisis would go away. But to get there, we need significant reform of regulation and litigation. Plus some direction-setting leadership to mobilize resources. That’s the opportunity for the survival-minded, as well as the bold.

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